Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003132309 |
---|---|
Provider Name | Kristen Collins |
First Address | Livonia, MI 48150-5633 |
Second Address | Southgate, MI 48195-2277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 12/04/2010 |